Healthcare Provider Details

I. General information

NPI: 1114792611
Provider Name (Legal Business Name): NEURO WATCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 CENTERVIEW DR STE 204
RALEIGH NC
27606-8012
US

IV. Provider business mailing address

5540 CENTERVIEW DR STE 204
RALEIGH NC
27606-8012
US

V. Phone/Fax

Practice location:
  • Phone: 714-206-6844
  • Fax:
Mailing address:
  • Phone: 714-206-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ALBION YI
Title or Position: OWNER
Credential:
Phone: 714-206-6844